— Medicaid growth a plus
Before it adjourns this month, the General Assembly faces a task on par with its biennial budget in terms of importance: What to do about expanding coverage for the uninsured?
Morally, it’s an easy call. More than 800,000 Hoosiers younger than 65 have no health insurance coverage.
Financially, there should be no hesitation to do so. A study by the University of Nebraska Medical Center estimates Indiana would see $3.4 billion in new economic activity by expanding coverage under the Affordable Care Act.
Gov. Mike Pence continues to stand strong in opposition to Medicaid expansion. But the decision is not his alone to make. Lawmakers’ best course is to position Indiana to negotiate with the federal government in providing health care for more than 400,000 residents who now fall in the gap between those eligible for Medicaid coverage under the state’s current guidelines and the 400,000 who will be eligible to participate in the health insurance exchanges.
Efforts pushed by the House Public Health Committee under Chairman Ed Clere, R-New Albany, would require Indiana to seek a middle ground between the Affordable Care Act and the Healthy Indiana Plan, which Pence wants to use. Clere’s plan includes an escape clause if the federal government doesn’t keep its spending commitment.
The issue doesn’t affect just the uninsured. The new study, commissioned by the Indiana Hospital Association, projects that a reduction in the number of uninsured Hoosiers would drive down the cost for Hoosiers with insurance. Individuals could save an average $236 a year; families would save $677.
Local health officials point to the benefit of reduced health care spending overall, as well as a regional economic benefit.
“What we see are a lot of (uninsured) people who have delayed care,” said Joe Dorko, CEO for Lutheran Health Network. “It’s much easier to treat hypertension than to put someone through open heart surgery.”
Dorko said hospitals currently must shift the cost of uncompensated care to commercial insurers, which is why health-insurance premiums are rising. Lutheran’s cost for uncompensated care in 2011 was $147 million.
Michael Packnett, president and CEO of Parkview Health, said the proposed expansion will cover about 45,000 people in the 10-county northeast Indiana region, with an estimated economic impact of $70 million to $90 million in Allen County alone over the next seven years. The expansion will sustain an estimated 3,000 jobs in the region and could create nearly 200 more.
“I hope we don’t miss the chance to do this,” Packnett said.
The Centers for Medicare and Medicaid Services would have to approve Indiana’s use of the Healthy Indiana Plan for Medicaid expansion, lifting the current cap of 40,000. HIP would also have to broaden its coverage to meet ACA requirements. But the go-ahead for an expansion plan in Arkansas suggests federal officials might support it.
Indiana lawmakers have a tough job ahead approving a two-year budget; a decision to expand Medicaid coverage to 400,000 Hoosiers is an easy call and the right one to make.
— The Journal Gazette, Fort Wayne
Donnelly and new same-sex marriage majority
Even Chief Justice John Roberts can sense the political winds shifting on gay marriage, famously saying during Supreme Court arguments last week that “political figures are falling over themselves” to get in line for marriage equality.
Just look at the U.S. Senate in recent weeks. In March, Sen. Rob Portman, an Ohio Republican, announced that his view had changed on same-sex marriage, largely influenced after finding out his son is gay. Since then, Sen. Bob Casey, D-Pa., Sen. Tom Carper, D-Del., and Sen. Mark Kirk, R-Ill., “fell over themselves” to put the tally of same-sex marriage backers at 50.
Welcome to the new majority, Sen. Joe Donnelly, recently elected Democrat from Indiana.
On Friday, Donnelly posted a statement on his Facebook page, discussing his opposition to amending the U.S. or Indiana constitutions “to enshrine in those documents an ‘us’ and a ‘them,’ instead of a ‘we.”’
“With the recent Supreme Court arguments and accompanying public discussion of same-sex marriage, I have been thinking about my past positions and votes,” Donnelly wrote, “In doing so, I have concluded that the right thing to do is to support marriage equality for all.”
There’s a certain amount of shock in the reaction. There also was a certain amount of convenience factored in, coming half a year after his election. In November, he positioned himself as a conservative Democrat who could be palatable to Republicans not settled on the tea party prospects offered by GOP candidate Richard Mourdock.
We’re not here to question his motives. Still, it’s funny what poll numbers can do.
An ABC/Washington Post poll released in March showed just how quickly the debate is rerouting. Nationwide, support to make gay marriage legal has increased from 32 percent in 2004 to 58 percent in 2012. The numbers are more striking when generations are considered, with support growing with each layer of younger voters polled.
Either way, it doesn’t take away from the fact that Donnelly is on to something here:
— Enshrining bans on gay marriage in the Constitution makes no sense.
— And the time is coming when the comfort level over same-sex unions is high enough that controversy will fade and the idea that the gay version of marriage will somehow diminish the traditional kind will be met with indifference.
Feel free to fall over yourself now.
— Journal & Courier, Lafayette